Provider Demographics
NPI:1942810411
Name:HERNANDEZ RIVAS, IVON
Entity Type:Individual
Prefix:
First Name:IVON
Middle Name:
Last Name:HERNANDEZ RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 W 24TH AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3982
Mailing Address - Country:US
Mailing Address - Phone:786-491-1909
Mailing Address - Fax:
Practice Address - Street 1:6445 W 24TH AVE APT 17
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3982
Practice Address - Country:US
Practice Address - Phone:786-491-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129729106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician